Thrombangiitis obliterans (Buerger's disease): still a limb threatening disease.

Details

Serval ID
serval:BIB_770DC7B19B01
Type
Article: article from journal or magazin.
Collection
Publications
Title
Thrombangiitis obliterans (Buerger's disease): still a limb threatening disease.
Journal
Acta Chirurgica Belgica
Author(s)
Van Damme H., De Leval L., Creemers E., Limet R.
ISSN
0001-5458[print], 0001-5458[linking]
Publication state
Published
Issued date
1997
Volume
97
Number
5
Pages
229-236
Language
english
Abstract
A series of 29 well-documented and properly analysed patients with thrombangiitis obliterans (Buerger's disease) is presented. The diagnosis of Buerger's disease was based on following criteria: smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, absence of atherosclerotic risk factors other than smoking. In the last 10 years (1986-1996), we identified 29 patients who met these rigid criteria. There were 24 men and 5 women, aged 32.4 years at the moment of the disease first clinical symptom. The cumulative tobacco use averaged 16 pack-years for each patient. The initial symptom was limited gangrene of a toe (n = 9) or a finger (n = 2), foot claudication (n = 6), calf claudication (n = 3), rest pain (n = 3), migratory superficial phlebitis (n = 4), and Raynaud phenomenon (n = 2). Angiography and/or Doppler ultrasound revealed digital, pedal and calf artery involvement in all patients, with proximal extension in ten patients (femoropopliteal in ten, including three cases with external iliac artery involvement). Seven patients had also evidence of upper limb involvement. Histologic proof was available in only seven patients. Only nine patients completely stopped smoking. Treatment was exclusively medical in five cases. Twenty-four underwent sympathectomy (20 at lumbar, and four at thoracic level), with good immediate result in 16. In 11 patients a vascular reconstruction was done (eight femorocrural and three iliofemoral bypasses), with a patency rate of only 36% at two years. Amputation was required in 16 patients (a mean of 2.7 amputations per patient) at one or more levels: toe (n = 19), forefoot (n = 5), below knee (n = 8), above knee (n = 2), finger (n = 3). Two patients ended up with bilateral leg amputation. Overall, 23% (7/30) of the patients required major leg amputation during the course of the disease. Disease progression was moderately related to continued tobacco use. Buerger's disease still entails considerable risk of major amputation. Complete abstinence from tobacco use is crucial to expect stabilization of the process. However, in advanced stages of the disease and despite cessation of smoking recurrent episodes of ischaemia or tissue loss are not excluded.
Keywords
Adult, Amputation, Female, Follow-Up Studies, Gangrene/etiology, Humans, Male, Middle Aged, Prognosis, Sympathectomy, Thromboangiitis Obliterans/complications, Thromboangiitis Obliterans/diagnosis, Tobacco Use Disorder/complications, Tobacco Use Disorder/rehabilitation, Treatment Outcome
Pubmed
Create date
29/10/2010 7:52
Last modification date
20/08/2019 14:34
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